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Office of Consumer Affairs c Business Regulation License or registration. valid for individu) use only
f =,! HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to
�!
- Reg 105543 Type: Office of Consumer Affairs and Business Regulation
10 Park Plaza - Suite 5170
Expiration 7/17/2012 Private Corporation
Boston, MA 02116
VALLEY HOME IMPROVEMENT-INC.
Nelson Shifflett
340 RiversideDr. g / —
Northampton, MA 01060 Undel-secretary Nyigalid with out signature
5 s:tchtiNetts - Department of 1't', fiat
?�®� Board of Br�iltlin Re2ulatinn., :in t ' tantl it tls
'' ona '.rr u t Supa°('hsor License
Une- and Tw F rally Jw'ellhngs
Licenser CS 60300
NELSON A SHIFFLETT
340 RIVERSIDE DR PBX60627
FLORENCE, MA 01062
E ;ir;ziosn: 9/22/2012
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DEPARTMENT OF BUILDING INSPECTIONS
114 *7-------:.----== --:
212 Main Stree ° Municipal Building
Northampt on, Mass. 01060 or "
WORMER'S COMPENSATION NSURANCE AFFIDAVFT
I, /4- L-504/' 5ili / i'i: 1/./(14 /
(Lioenstercrmittee)
with a principal place of business/residence a/: .
3 'to iej/ ./.6 2_ h (phoneg) . '17 e-/- 7) .2
(6-1----Lkity/5uatelzip) 125 0
do hereby certify, under the pains and pennItiies of perjury, that:
(X) 1 am an employer providing the following worker's compensation coverage for my
employees Wed ng on this job:
0:),C. F6 ci 55"o /
(Insur2nce compan cPolic Nurrir) (Expiration Dnip)
( ) am a sole proprietor, general caitractor or homeowner (circle One) and have hired
the contractors listed below who have the folio - wing worker's compensation policies:.
(Name of Contractor) (1nsmanoc Company/Policy Number) (Expiration Date)
(Name of Contactor) (Tain_ran Company(Policy Number) (Expiratioa Date)
(Name of Contractor) (f.asinranct Company/Policy Number) (Expiration Date)
(Nq inf. of rrntractor) (lacat Coadpaii Nur . 1.11.) (Expiradon Data)
(atisch . .arlditicztal shed if516 to 1A&h1d infornuth pt-Rini.r.t if) all cos
( ) 1 an a sole proprietor and have no one working for me.
( ) /am. a home owner perfax . -- ro, I ciig ail the work_ myself.
N awar . v? thi l `' ".r.- W h' 3 '''''''----g." r ',al; :1) r..--,:),..iltz.7.7.-;... ,-- r.-1- ,r,:-:----,, ,-., ct.,,,._!,-,: .-,•-
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1.--, svi of as...- ar.,74yz.° t.lz,-clz- :La Woi1c.c.?,;
1 Lill, '-c-- ',.,-.2:11.ci 6 '21 -- -p.y of ,23_ may !-.. le,-A,, iz tb D-z-75._=,,-0---,t 017 Aris& 0.61d of T"===c= fo th
v&F-1_fftiet alIfit1,53,e failure to smire, covemg.511y14 i=pri, 25A cfMUL 152 c--ii, teliAi to it-0 iriglo of r=rimii-LR1 {1,-
-- of a 6-4 of W10 S 4500.00 f--e k.17 Of UZI° 0 - 0 4 - . C ' S A r___ CIA 1=.1 in if. ()fa Stcp WoEkor&f. ad a
fno nf !WIN a cy EtIllitQl.
1- '
Sign&I 11,1± t— day of /i
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F 07.- ( wa ..1
( Permit 1 _
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SECTION 8 - CONSTRUCTION SERVICES i
.1 Licensed Construction Supervisor: Not Applicable 0
Name of License Holder : Nelson Shif f 060300
Valley Home Improvement, Inc. boons() Number
- —
340 Riverside Drive, Northampton, MA 0106.0_ 1 9/22/'
. Address I Expiration Date
I
584 -7522
S gnature Telephone
3. Registered H. ,, a tm. rovernent Contractor; Nct Applicable 0
Valley Home Improvement, Inc..__ 105543
Company Name Registration Number
340 Riverside Drive -- 7/17 /12.
Address Expiration Date
Northampton, MA 01060 Te;ephor,e 584 - 7522
SECTION 10- WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 152, § 25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this af'iravit 1
la. dill result in the denial of the issuance of the building permit._
Signed Affidavit Attached Yes XI No 0
7 Horne Owner Eat rnpt on
' fhe current exemption for "homeowners" Was extended to include Ov rter- o ccupied Dwellings of one (1) or two(2) families
and to allow such homeowner to engage an individual for hire who does not possess a license, provided that the owner acts
as supervisor. CMR 780. Sixth Edition Section 108.3.5.1.
Definition of Homeowner: Person (s) who own a parcel of land on which he/she resides or intends to reside, on which there
is, or is intended to be, a one or two family dwelling, attached or detached structures accessory to such use and! or farm
structures. .A person who constructs more than one home in a two -wear period shall not be considered a homeowner.
Such "homeowner" shall submit to the Building Official, on a form acceptable to the Building Official, that hcfshc shall be
responsible for all such work performed under the building permit.
As acting Construction Supervisor your presence on the job site will be required from tine to time, during and upon
completion of the work for which this permit is issued.
Also be advised that with reference to Chapter 152 (Workers' Compensation) and Chapter 153 (Liability of Employers to
Employees for injuries not resulting in Death) of the Massachusetts General Laws Annotated, von may be liable for eerson(s)
you hire to perform work for you under this permit.
The undersigned "homeowner" certifies and assumes responsibility for compliance with the State Building Code, City of
Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated.
floweowner Signature
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.. ECT:CIN 7„1.• OWNER AUTHOPAZAr , TO CC COrAPLETCO WilEt4
0Vt.VERS AGENT OR CONTRiteTCP AP. FOR ilt ILDING PERMIT
//
Nelson Shifflett, Valley Home Improvement, Inc.
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Nelson Shifflett , •
I Vit4i/°
Section 4.
ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE
DENIED DUE TO LACK OF INFORMATION
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Side L: R: L: R:
Rear
Building Height
Bldg. Square Footage
1141
Open Space Footage
(Lot area minus bldg & paved
parking)
# of Parking Spaces
Fill:
(volume & Location)
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO DON'T KNOW YES
IF YES, date i ued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW YES
IF YES: enter Book Page and /or Document #
B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW
YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained , Date Issued:
C. Do any signs exist on the property? YES NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property ?YES
No
IF YES, describe size, type and location:
' �� ��*
J�^° ������ cs�,��rx o ---^
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���
__ _ _. ~ i/ �� , ��, V-- m�,~ = *� C
Department use only i
Building Department
` - ) City of Northampton
SO - 212 Main Street
Room 100
Curb Cut/Driveway Permit ,, -
Sewer/Septic Availability . .,
\o/ 01060 • n e 413-587-12/1-0 Fax 413-587-1272 Plot/Site Plans' Two Sets of Structural Plans
Vill.- APPLICATION TO CONSTRUCT, ALTER, _______
SECTION 1 - SITE INFORMATIO
|etodbyuf�ce
1.1 Property Address:
, �--' to be completed
3 ����� � ��� Map _ Lot _Unit __
�' ' ., ./-v ~^ --- _ ,'- -_ _
^ c /��/y� �� Zone Overlay District
'~ -._�"~°- ^'^^, -'~ =._-
8m St, District C8 District i
SECTION 2 - PROPERTY OYYWEQ5H1P/AUTHOFHZED AGENT
— -- - —
i 2� Owner o� Record: . �|� "�*- i�/
��
~� �Zr a ��
-- --- ---
Current N.loding Adurcsc
Teep»nno ^ /~� t^�
Signature �� _ ~u, ur L'«� � ^� _ _
2.2 Authorized Agent: Nelson Shifflett
Valley Home Improvement, Inc. P.O. Box 60627, FImrezzoe"_MA J}1OG2
Name (Ptwit) Current �u]ing Address:
S84-7522___
Signature re|rrhone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
! - - � -- -
Item ' Ect be Official Use Only
completed by permit applicant _ |
l. Building (a) Building Permit Fee
_
2. E|ecthoo| (b) Estimated Total Cost of
/0 0 Construction from 6)
3. Plumbing Building Permit Fee
| -- --
4. Mechanica|(HVAC)
5. Fire Protection _ _ ~ . ~~/__ _
-- - ---� --' � F V . ��
6. Total =(l + 2 + 3 + + 5) Check Number ^ 0� _ 47
____��
This Section _ _ _
Building Permit Number: _ ___ -- -
- Date Issued,: __ - _-_--__- _
_ _ --. __ __ _ -- - __ _
Signature: . '-- --- ------'- |
Building Cvmm _ __ Date _ _ __ __
File # BP- 2012 -0550
APPLICANT /CONTACT PERSON VALLEY HOME IMPROVEMENT INC
ADDRESS/PHONE P 0 BOX 60627 FLORENCE (413) 584 -7522
PROPERTY LOCATION 30 FAIRFIELD AVE
MAP 17C PARCEL 176 001 ZONE URB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out --- `'
Fee Paid 0 1I L 5
Tvpeof Construction: REROOF 4 SO & INSULATE ATTIC
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License 060300
3 sets of Plans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO ION PRESENTED:
Approved Additional permits required (see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan AND /OR Special Permit With Site Plan
Major Project: Site Plan AND /OR Special Permit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding Special Permit Variance*
Received & Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Commission Permit DPW Storm Water Management
Demolition elay
" Iir 7 ./A' '
--
. e of Built (g Official Date
Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain all required permits from Board of Health, Conservation Commission, Department
of public works and other applicable permit granting authorities.
* Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of
Planning & Development for more information.
30 FAIRFIELD AVE BP- 2012 -0550
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 17C - 176 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: INSULATION BUILDING PERMIT
Permit # BP- 2012 -0550
Project # JS- 2012- 000921
Est. Cost: $6000.00
Fee: $55.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: VALLEY HOME IMPROVEMENT INC 060300
Lot Size(sq. ft.): 5880.60 Owner: DURKEE MARY A
Zoning: URB(100)/ Applicant: VALLEY HOME IMPROVEMENT INC
AT: 30 FAIRFIELD AVE
Applicant Address: Phone: Insurance:
P 0 BOX 60627 (413) 584 -7522 Workers Compensation
FLORENCEMA01062 ISSUED ON:12/8/2011 0:00:00
TO PERFORM THE FOLLOWING WORK:REROOF 4 SQ & INSULATE ATTIC
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: Service: Meter:
Footings:
Rough: Rough: House # Foundation:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace /Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy Signature:
FeeType: Date Paid: Amount:
Building 12/8/2011 0:00:00 $55.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner